inflamatia nespecifica
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Inflamatia nespecificaInflamatia nespecifica
Dr. Irina Moise
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Definitie inflamatie
Def.-modalitate de reactie si aparare ale organismului fata de agresiunea unor agenti din mediu.
Cauze:microbi, virusuri, fungi, protozoare, paraziti, alergeni, ag.fizici, ag.chimici, corpi straini.
Clinic-tumor calor dolor rubor fc laesa(Celsius)
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FiziopatologieFiziopatologie1. Vasodilatatie-hiperemie activa2. Creste permeabilitatea vasculara (trecerea in
plasma a albuminelor, fibrinogenului, globulinelor)-Exudare
3. Staza sanguina-incetinirea vitezei sangelui 4. Marginatie leucocitara5. Migrare leucocitara (diapedeza)6. Restitutio ad integrum (in infl. usoare, e
posibila vindecarea fara sechele)7. Tesut granulatie8. Cicatrice
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Mediatori chimiciMediatori chimici
Agentii care produc infl nu actioneaza direct ci prin mediatori chimici ce au origine in plasma celule si tesuturi: amine vasoactive (histamina-degranulare mastocitara si serotonina),proteaze plasmatice(sistemul kininelor –bradikinina si kalikreina, sistemul complementului C3a, C5a, C5b-9, sistemul de coagulare activat de f.Hageman), metaboliti acid arahidonic (TXA2, LT, PG-vasodilatatie/constrictie), constituenti lizozomali, radicali liberi derivati din O2, Fact de activare plachetara(vasodilatatie, creste permeabilitatea venulelor, chemotaxie, aderenta leucocitelor la endoteliu), citokine
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Celule inflamatoriiCelule inflamatoriiLeucocite (PMN), Monocite(limfocite, plasmocite), Celule mezenchimale locale (histiocite,
fibroblaste, endotelii capilare)
ClasificareClasificareDupa:Etiologie-nespecifice(exudat)/specificeEv.in timp-acute/subacute/croniceMorfologie-exudative/alterative/proliferative
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Meningita-MacroscopicMeningita-Macroscopic-leziune infl acuta exudativa fibrino-purulenta cu
prognostic grav, prin difuziunea in spatiul arahnoidian si atingerea sistemului ventricular si tesutului cerebral
-Etiologie:bacteriana (Neisseria Meningitis, Pneumococus, Streptococus, E.Coli, Haemophilus Influenzae)
-Macro:LCR-tulbure purulent;Meninge-luciu sters, cu structura membranara purulenta difuza, cu atingere a convexitatii creierului, sau interpeduncular
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Meningita-MicroscopicMeningita-MicroscopicHE: Dg de organ-prezenta de zona corticala
cerebrala;Piamater=o banda intens colorata roz-rosu si vase; S.nervoasa=celule nervoase, gliale, fibre
Leziunea:-hiperemie activa, exudat seros slab acidofil asociat cu PMN, retea de fibrina, infiltrat difuz cu PMN+umbre celulare la care nu se evid nucleul(piocite) si edem al substantei cerebrale
Dg+ de leziune:-inflamatie exudativa purulenta;DD:meningita TBC, Seroasa, din antrax
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MeningitaMeningita
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Abcesul Hepatic-MacroscopicAbcesul Hepatic-Macroscopic-infl exudativa purulenta cu poarta de intrare biliara
(colangita), venoasa(apendicita, infl vena ombilicala +pileflebita),arteriala (abces pioemic)
-Ab pioemic:abcese multiple cu diam. F mici (ab miliare), infectia ficat concomitenta cu infectie sistemica, ficat congestiv friabil, cu noduli galbeni cu aureola hemoragica
-Ab pileflebitic:aglomeratie de abcese multiple separate unele de altele prin pereti incompleti-ab areolar Chauffard
-Ab colangitic:puroi cu tenta verde, ficat poros ca un burete imbibat in puroi.
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Abcesul Hepatic-MicroscopicAbcesul Hepatic-MicroscopicHE-dg organ:org parenchimatos cu travee celulare hepatice, cu pol vascular si pol biliar, vena centrolobulara, spatiu port la periferia lobulului hepatic, format din-venula+arteriola+canal biliar-dg leziune:cantitati uriase de PMN, piocite, germeni, delimitat prin tesut de granulatie cu vase de neoformatie si tendinta fibropara (formarea membranei piogene-incapsulare), hepatocite cu degenerescenta nucleo-citoplasmatica-dg+: supuratie circumscrisa de tipul abcesului hepatic .
-DD:abces colangitic (pigment si fara incapsulare), abces piemicarteriogen care sunt numeroase,mici fara tendinta la delimitare.
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Abcesul HepaticAbcesul Hepatic
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Apendicita acuta-MacroscopicApendicita acuta-MacroscopicDescriere:Apendic turgescent,desen vascular
accentuat, Luciu seroasei sters Perete ingrosat friabil Continutul lumenului purulent
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Apendicita acuta-MicroscopicApendicita acuta-MicroscopicDescriere:Apendicita acuta flegmonoasa este o inflamatie acuta exudativ purulenta
care infiltreaza peretele apendicular.Apare mai frecvent la adolescenti.Etiopat-colibacili,stafilococi,streptococi,anaerobi.Obstructia este data de fecaloame,calculi tumori.Micro-Dg. De organ-mucoasa-epiteliu de tip intestinal cu celule cilindrice intrepatrunse cu celule
caliciforme corion-foliculi limfoizi cu centri clari.Muscularis mucosae-putin perceptibilaMusculara-muschi netezi transversali si longitudinali.Peritoneu visceral.Dg.leziune-continut cavitate-exudat purulent-pmn.piocite mononucleare,hematii
detritus necrotic.Detritus inflamator disecant intramural.Dd-apendicita acuta catarala; -abcesul apendicular; -apendicita perforata.
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Apendicita acutaApendicita acuta
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Pleurezia fibrinoasa-MacroscopicPleurezia fibrinoasa-MacroscopicDefinitie:-inflamatia pleurei ;se poate asocia
bolilor pulmonare-TBC,pneumonie,infarct pl. abcese pl.bronsiectazii ;boli sistemice-PR,lupus eritematos,uremie;
Macro-pleura viscerala –aspect eritematos,luciu sters,rosu violaceu,false membrane aspect reticulat sau vilos.-”tartina unsa cu unt desprins”
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Pleurezia fibrinoasa-MicroscopicPleurezia fibrinoasa-MicroscopicDescriere-Dg. Organ-tesut parenchimatos
policavitar marginit de mezoteliu unistratificat, membrana bazala.
Mezoteliu de suprafata partial disparut Stroma conjunctiva hiperemica,filamente de
fibrina eozinofila,rare limfocite;Dg. Pozitiv-Retea plexiforma eozinofila atasata
la corion si parenchim pulmonarintens hiperemic.
Dd-pleurita fibrinoasa tbc.-foliculi tbc,necroza de cazeificare;
-pleurita purulenta-pmn. -pleurita hemoragica; -pleurita gangrenoasa; -neoplazii primitive /secundare
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Pleurezia fibrinoasaPleurezia fibrinoasa
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Parotidita epidemica-oreillonParotidita epidemica-oreillonDescriere-sialoadenita parotidiana-inflam.exudativa acuta-
virusul urlian-paramixovirus.Boala infect. A copilariei -5-15 ani-inflamatia tranzitorie a gl.
Parotide/salivare.Macro-tumefierea paarotidei,febra,cresterea locala a
temperaturii prindere sublinguala.Micro-Dg. Organ-organ parenchimatos cu grupuri de celule
grupate pericavitati virtuale structura fin granulara a citoplasmei-glanda seroasa;canale excretorii;stroma vasculara;
Descrierea leziunii-exudat seros rare histiomonocitehiperemie,edem.
Dd-parotidita supurata -Sdr.Sjogren-xerostomie(red.secr.gl.saliv) red.secr.mucus gl.nazale red.secr.gl. lacrimale-keratoconj -Sd.Mikulicz-asocierea de lez.inflam.ale gl.salivare si
lacrimale.
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Hepatita epidemicaHepatita epidemica
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Enterita ulcero-necrotica-MacroEnterita ulcero-necrotica-MacroDescriere-inflamatie in care predomina
lez.distrofice alterative celulare ,tesut necrozat si ulceratie.
etiologie:Salmonella Shigela,Campilobacter juni,clostridium,stafilococ,E.colli,imunodeficiente-flora proprie;
Patogeneza-sdr.diareic incriminat in asocierea elem.enteroinvazive cu ulceratia muc.
-endotoxine fara ulceratia muc. Macro-muc.hiperemica,ulcerata ,hiperplazie de
foliculi limfoizi; -pseudomembrane alb-galbui -exudat seros al seroasei.
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Enterita ulcero-necrotica-MicroEnterita ulcero-necrotica-MicroDescriere-Dg.organ-mucoasa-epiteliu cilindric
intestinalcu placuta striata si celule caliciforme; vilozitati intestinale;corion cu glande Liberkuhn;submucoasa –tesut laxcu elem.limfoide; musculara mucosae-fibre musculare int.-circulare, ext.-longitudinale.
Dg.de leziune-enteropatie ulceronecrotica ;Dd-enterita catarala -enterita foliculara -enterita purulenta -inflam.specifice-tbc.dizenterie,inflam.tifice.
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Enterita ulcero-necroticaEnterita ulcero-necrotica